Korean J Radiol.  2018 Aug;19(4):585-596. 10.3348/kjr.2018.19.4.585.

Recent Update of Embolization of Postpartum Hemorrhage

Affiliations
  • 1Department of Radiology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450000, China.
  • 2Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea. jhshin@amc.seoul.kr

Abstract

Postpartum hemorrhage (PPH) is a life-threatening condition and remains a leading cause of maternal mortality. Transcatheter arterial embolization (TAE) is an effective therapeutic strategy for PPH with the advantages of fast speed, repeatability, and the possibility of fertility preservation. We reviewed the vascular anatomy relevant to PPH, the practical details of TAE emphasizing the timing of embolization, and various clinical conditions of PPH according to a recent literature review.

Keyword

Postpartum hemorrhage; Transcatheter arterial embolization; Embolic materials

MeSH Terms

Fertility Preservation
Maternal Mortality
Postpartum Hemorrhage*
Postpartum Period*

Figure

  • Fig. 1 Vascular anatomy relevant to PPH.A. Schema of IIA and its branches. 1, common iliac artery; 2, external iliac artery; 3, inferior epigastric artery; 4, IIA; 5, superior vesical artery; 6, obturator artery; 7, UA; 8, internal pudendal artery; 9, inferior gluteal artery; 10, superior gluteal artery; 11, lateral sacral artery; 12, iliolumbar artery; 13, piriformis muscle; and 14, sacrospinous ligament. B. Left IIA arteriogram in right anterior oblique projection (20°). 1, IIA; 2, external iliac artery; 3, lateral sacral artery; 4, UA; 5, inferior gluteal artery; 6, internal pudendal artery; 7, obturator artery; 8, vesical artery; 9, superior gluteal artery; and 10, iliolumbar artery. IIA = internal iliac artery, PPH = postpartum hemorrhage, UA = uterine artery

  • Fig. 2 35-year-old woman with primary PPH due to uterine atony.A. Left internal iliac arteriogram in frontal projection shows typical tortuous shape of UA (arrows). B. Selective arteriogram of left UA shows enlarged UA (arrow) which supplies enlarged uterus with numerous intramural branches (arcuate arteries, arrowhead). Cobra catheter (white arrows) was used to catheterize contralateral left UA (inset). C. Right internal iliac arteriogram in frontal projection demonstrates tortuous, enlarged UA with characteristic descending (arrowhead), transverse, and ascending segments (arrow). Ipsilateral, right UA was selected with Cobra catheter using Waltman loop (white arrows in inset). Bilateral UAs were embolized using gelatin sponge particles (not shown). D. Completion arteriogram shows no visualized bilateral UAs.

  • Fig. 3 34-year-old woman with primary PPH three hours after vaginal delivery.There was vaginal laceration, which could not be controlled with vaginal packing and suture.A. Initial, right internal iliac arteriogram shows contrast extravasations (arrows) in vaginal branches from anterior division of IIA. Several bleeders, including vaginal branches, were embolized with NBCA and microcoil, after which bilateral UAs were embolized with gelatin sponge particles (not shown). However, persistent contrast extravasation was noted. Therefore, right IIA was embolized with gelatin sponge particles (not shown). B. Vaginal bleeding recurred four hours later. Axial contrast-enhanced CT scan shows active bleeding (arrow) in right paravaginal hematoma. Note vaginal packing (arrowhead). C. In second session, aortogram demonstrates contrast extravasation at lower pelvis level. Subsequent, selective inferior mesenteric arteriogram shows contrast extravasations (arrow) in distal branch which was embolized with NBCA (not shown). NBCA = N-butyl cyanoacrylate

  • Fig. 4 40-year-old woman with decreased hemoglobin level following cesarean section.However, obvious vaginal hemorrhage was not found.A. Axial enhanced CT scan shows large hematoma with active bleeding focus (arrow) within rectus abdominis muscle. Small amount of hematoma is found in endometrial cavity without active bleeding. B. Selective left inferior epigastric arteriogram demonstrates no active bleeding. However, subsequent, selective right inferior epigastric arteriogram demonstrates contrast extravasation (arrows). C. Completion, fluoroscopic image shows NBCA cast (arrows) of right inferior epigastric artery. Additional angiogram of right superior epigastric artery demonstrates no active bleeding focus.

  • Fig. 5 39-year-old woman with placenta accreta, presenting with PPH after cesarean section.A, B. Early and delayed, right internal iliac arteriograms show multiple, tortuous UA branches (arrowheads in A) and extensive trophoblastic vascularization of placental intervillous spaces (arrowheads in B). Note embolized left UA with gelatin sponge particles (arrow). There was continued vaginal bleeding after bilateral UAs embolization with gelatin sponge particles. C. Selective, right ovarian artery angiogram shows reflux into UA (arrow). Faint ovarian blush (arrowhead) is also visible. Right ovarian artery was embolized with gelatin sponge particles.

  • Fig. 6 33-year-old woman with arteriovenous malformation, presenting with secondary PPH after cesarean section.A. Arterial phase of axial enhanced CT scan shows hypervascular lesion (arrow) in uterine cavity. B. Left internal iliac arteriogram shows hypervascular lesion (arrow) with enlarged tortuous UA. C. Selective angiogram of right UA shows hypervascular lesions (arrows) and parenchymal defect (arrowhead) due to embolization of left UA. Bilateral UAs were embolized with gelatin sponge particles.

  • Fig. 7 38-year-old woman with vaginal bleeding after cesarean section.A, B. Bilateral internal iliac arteriogram in frontal projection shows hypertrophied bilateral UAs. However, vaginal bleeding was persistent after adequate embolization of both UAs using gelatin sponge particles. C. Pelvic aortography demonstrates right round ligament artery (not shown). Selective angiography of right round ligament artery (arrow) shows uterine stains (arrowhead). D. Image obtained during embolization shows right round ligament artery (arrow) and right inferior epigastric artery (arrowhead) filled with mixture of contrast medium and gelatin sponge particles. Embolization was performed at level of inferior epigastric artery because of failure of superselection of round ligament artery. Vaginal bleeding ceased after right round ligament artery embolization.


Cited by  1 articles

Perspective of the comparative effectiveness of non-pharmacologic managements on postpartum hemorrhage using a network meta-analysis
Kyung Ju Lee, Kwan Hong, Hari Hwang, Hijeong Choi, Sangho Sohn
Obstet Gynecol Sci. 2020;63(5):605-614.    doi: 10.5468/ogs.20080.


Reference

1. Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg. 2010; 110:1368–1373. PMID: 20237047.
Article
2. Delotte J, Novellas S, Koh C, Bongain A, Chevallier P. Obstetrical prognosis and pregnancy outcome following pelvic arterial embolisation for post-partum hemorrhage. Eur J Obstet Gynecol Reprod Biol. 2009; 145:129–132. PMID: 19398259.
Article
3. Deneux-Tharaux C, Dupont C, Colin C, Rabilloud M, Touzet S, Lansac J, et al. Multifaceted intervention to decrease the rate of severe postpartum haemorrhage: the PITHAGORE6 cluster-randomised controlled trial. BJOG. 2010; 117:1278–1287. PMID: 20573150.
Article
4. Sentilhes L, Vayssière C, Deneux-Tharaux C, Aya AG, Bayoumeu F, Bonnet MP, et al. Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). Eur J Obstet Gynecol Reprod Biol. 2016; 198:12–21. PMID: 26773243.
5. Sheldon WR, Blum J, Vogel JP, Souza JP, Gülmezoglu AM, Winikoff B. WHO Multicountry Survey on Maternal and Newborn Health Research Network. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization multicountry survey on maternal and newborn health. BJOG. 2014; 121(Suppl 1):5–13. PMID: 24641530.
Article
6. Gonsalves M, Belli A. The role of interventional radiology in obstetric hemorrhage. Cardiovasc Intervent Radiol. 2010; 33:887–895. PMID: 20464555.
Article
7. Soyer P, Dohan A, Dautry R, Guerrache Y, Ricbourg A, Gayat E, et al. Transcatheter arterial embolization for postpartum hemorrhage: indications, technique, results, and complications. Cardiovasc Intervent Radiol. 2015; 38:1068–1081. PMID: 25677130.
Article
8. Palacios Jaraquemada JM, García Mónaco R, Barbosa NE, Ferle L, Iriarte H, Conesa HA. Lower uterine blood supply: extrauterine anastomotic system and its application in surgical devascularization techniques. Acta Obstet Gynecol Scand. 2007; 86:228–234. PMID: 17364288.
Article
9. Chang S, Lee MS, Kim MD, Yoon CJ, Jung DC, Lee M, et al. Inferior mesenteric artery collaterals to the uterus during uterine artery embolization: prevalence, risk factors, and clinical outcomes. J Vasc Interv Radiol. 2013; 24:1353–1360. PMID: 23891048.
Article
10. Ojala K, Perälä J, Kariniemi J, Ranta P, Raudaskoski T, Tekay A. Arterial embolization and prophylactic catheterization for the treatment for severe obstetric hemorrhage*. Acta Obstet Gynecol Scand. 2005; 84:1075–1080. PMID: 16232175.
Article
11. Lee HJ, Jeon GS, Kim MD, Kim SH, Lee JT, Choi MJ. Usefulness of pelvic artery embolization in cesarean section compared with vaginal delivery in 176 patients. J Vasc Interv Radiol. 2013; 24:103–109. PMID: 23273701.
Article
12. Soyer P, Boudiaf M, Jacob D, Hamzi L, Pelage JP, Le Dref O, et al. Bilateral persistent sciatic artery: a potential risk in pelvic arterial embolization for primary postpartum hemorrhage. Acta Obstet Gynecol Scand. 2005; 84:604–605. PMID: 15901276.
Article
13. van Hooft IM, Zeebregts CJ, van Sterkenburg SM, de Vries WR, Reijnen MM. The persistent sciatic artery. Eur J Vasc Endovasc Surg. 2009; 37:585–591. PMID: 19231248.
Article
14. Gipson MG, Smith MT. Endovascular therapies for primary postpartum hemorrhage: techniques and outcomes. Semin Intervent Radiol. 2013; 30:333–339. PMID: 24436559.
Article
15. Park KJ, Shin JH, Yoon HK, Gwon DI, Ko GY, Sung KB. Postpartum hemorrhage from extravasation or pseudoaneurysm: efficacy of transcatheter arterial embolization using N-butyl cyanoacrylate and comparison with gelatin sponge particle. J Vasc Interv Radiol. 2015; 26:154–161. PMID: 25454736.
Article
16. Worthington-Kirsch RL. Uterine artery embolization: state of the art. Semin Intervent Radiol. 2004; 21:37–42. PMID: 21331107.
Article
17. Leleup G, Fohlen A, Dohan A, Bryan-Rest L, Le Pennec V, Limot O, et al. Value of round ligament artery embolization in the management of postpartum hemorrhage. J Vasc Interv Radiol. 2017; 28:696–701. PMID: 28292635.
Article
18. Wi JY, Kim HC, Chung JW, Jun JK, Jae HJ, Park JH. Importance of angiographic visualization of round ligament arteries in women evaluated for intractable vaginal bleeding after uterine artery embolization. J Vasc Interv Radiol. 2009; 20:1031–1035. PMID: 19560937.
Article
19. Lee HY, Shin JH, Kim J, Yoon HK, Ko GY, Won HS, et al. Primary postpartum hemorrhage: outcome of pelvic arterial embolization in 251 patients at a single institution. Radiology. 2012; 264:903–909. PMID: 22829685.
Article
20. Kirby JM, Kachura JR, Rajan DK, Sniderman KW, Simons ME, Windrim RC, et al. Arterial embolization for primary postpartum hemorrhage. J Vasc Interv Radiol. 2009; 20:1036–1045. PMID: 19647182.
Article
21. Chauleur C, Fanget C, Tourne G, Levy R, Larchez C, Seffert P. Serious primary post-partum hemorrhage, arterial embolization and future fertility: a retrospective study of 46 cases. Hum Reprod. 2008; 23:1553–1559. PMID: 18460450.
Article
22. Ganguli S, Stecker MS, Pyne D, Baum RA, Fan CM. Uterine artery embolization in the treatment of postpartum uterine hemorrhage. J Vasc Interv Radiol. 2011; 22:169–176. PMID: 21183360.
Article
23. Olowokere AE, Adekeye OA, Ogunfowokan A, Olagunju OE, Irinoye OO. The prevalence, management and outcome of primary postpartum haemorrhage in selected health care facilities in Nigeria. Int J Nurs Midwifery. 2013; 5:28–34.
Article
24. Gizzo S, Saccardi C, Patrelli TS, Di Gangi S, Breda E, Fagherazzi S, et al. Fertility rate and subsequent pregnancy outcomes after conservative surgical techniques in postpartum hemorrhage: 15 years of literature. Fertil Steril. 2013; 99:2097–2107. PMID: 23498891.
Article
25. Healey S, Buzaglo K, Seti L, Valenti D, Tulandi T. Ovarian function after uterine artery embolization and hysterectomy. J Am Assoc Gynecol Laparosc. 2004; 11:348–352. PMID: 15559347.
Article
26. Machado LS. Emergency peripartum hysterectomy: incidence, indications, risk factors and outcome. N Am J Med Sci. 2011; 3:358–361. PMID: 22171242.
Article
27. Ko HK, Shin JH, Ko GY, Gwon DI, Kim JH, Han K, et al. Efficacy of prophylactic uterine artery embolization before obstetrical procedures with high risk for massive bleeding. Korean J Radiol. 2017; 18:355–360. PMID: 28246515.
Article
28. Cali G, Forlani F, Giambanco L, Amico ML, Vallone M, Puccio G, et al. Prophylactic use of intravascular balloon catheters in women with placenta accreta, increta and percreta. Eur J Obstet Gynecol Reprod Biol. 2014; 179:36–41. PMID: 24965977.
Article
29. Yi KW, Oh MJ, Seo TS, So KA, Paek YC, Kim HJ. Prophylactic hypogastric artery ballooning in a patient with complete placenta previa and increta. J Korean Med Sci. 2010; 25:651–655. PMID: 20358016.
Article
30. Fuchs KM, Miller RS, Berkowitz RL. Optimizing outcomes through protocols, multidisciplinary drills, and simulation. Semin Perinatol. 2009; 33:104–108. PMID: 19324239.
Article
31. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: clinical management guidelines for obstetrician-gynecologists number 76, October 2006: postpartum hemorrhage. Obstet Gynecol. 2006; 108:1039–1047. PMID: 17012482.
32. Matsubara S, Sato T, Nakata M. Vaginal artery embolization with a permanent embolic agent for intractable postpartum hemorrhage. J Obstet Gynaecol Res. 2011; 37:377–378. PMID: 21418425.
Article
33. Kim GM, Yoon CJ, Seong NJ, Kang SG, Kim YJ. Postpartum haemorrhage from ruptured pseudoaneurysm: efficacy of transcatheter arterial embolisation using N-butyl-2-cyanoacrylate. Eur Radiol. 2013; 23:2344–2349. PMID: 23559143.
Article
34. Obata S, Kasai M, Kasai J, Seki K, Sekikawa Z, Torimoto I, et al. Emergent uterine arterial embolization using N-butyl cyanoacrylate in postpartum hemorrhage with disseminated intravascular coagulation. Biomed Res Int. 2017; 2017:1562432. PMID: 28251148.
Article
35. Cottier JP, Fignon A, Tranquart F, Herbreteau D. Uterine necrosis after arterial embolization for postpartum hemorrhage. Obstet Gynecol. 2002; 100(5 Pt 2):1074–1077. PMID: 12423810.
Article
36. Park HS, Shin JH, Yoon HK, Kim JH, Gwon DI, Ko GY, et al. Transcatheter arterial embolization for secondary postpartum hemorrhage: outcome in 52 patients at a single tertiary referral center. J Vasc Interv Radiol. 2014; 25:1751–1757. PMID: 24985718.
Article
37. Dohan A, Soyer P, Subhani A, Hequet D, Fargeaudou Y, Morel O, et al. Postpartum hemorrhage resulting from pelvic pseudoaneurysm: a retrospective analysis of 588 consecutive cases treated by arterial embolization. Cardiovasc Intervent Radiol. 2013; 36:1247–1255. PMID: 23756881.
Article
38. McGonegle SJ, Dziedzic TS, Thomas J, Hertzberg BS. Pseudoaneurysm of the uterine artery after an uncomplicated spontaneous vaginal delivery. J Ultrasound Med. 2006; 25:1593–1597. PMID: 17121956.
Article
39. Sharma AM, Burbridge BE. Uterine artery pseudoaneurysm in the setting of delayed postpartum hemorrhage: successful treatment with emergency arterial embolization. Case Rep Radiol. 2011; 2011:373482. PMID: 22606544.
Article
40. Kim YJ, Yoon CJ, Seong NJ, Kang SG, An SW, Kim YS, et al. Failed pelvic arterial embolization for postpartum hemorrhage: clinical outcomes and predictive factors. J Vasc Interv Radiol. 2013; 24:703–709. PMID: 23622042.
Article
41. Doumouchtsis SK, Nikolopoulos K, Talaulikar V, Krishna A, Arulkumaran S. Menstrual and fertility outcomes following the surgical management of postpartum haemorrhage: a systematic review. BJOG. 2014; 121:382–388. PMID: 24321038.
Article
42. Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L. Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage. BJOG. 2010; 117:84–93. PMID: 19832826.
Article
43. Hardeman S, Decroisette E, Marin B, Vincelot A, Aubard Y, Pouquet M, et al. Fertility after embolization of the uterine arteries to treat obstetrical hemorrhage: a review of 53 cases. Fertil Steril. 2010; 94:2574–2579. PMID: 20381035.
Article
44. Eriksson LG, Mulic-Lutvica A, Jangland L, Nyman R. Massive postpartum hemorrhage treated with transcatheter arterial embolization: technical aspects and long-term effects on fertility and menstrual cycle. Acta Radiol. 2007; 48:635–642. PMID: 17611871.
Article
45. Nikolic B, Spies JB, Campbell L, Walsh SM, Abbara S, Lundsten MJ. Uterine artery embolization: reduced radiation with refined technique. J Vasc Interv Radiol. 2001; 12:39–44. PMID: 11200352.
Article
46. Andrews RT, Brown PH. Uterine arterial embolization: factors influencing patient radiation exposure. Radiology. 2000; 217:713–722. PMID: 11110933.
Article
47. Tse G, Spies JB. Radiation exposure and uterine artery embolization: current risks and risk reduction. Tech Vasc Interv Radiol. 2010; 13:148–153. PMID: 20723828.
Article
48. Salomon LJ, deTayrac R, Castaigne-Meary V, Audibert F, Musset D, Ciorascu R, et al. Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. A cohort study. Hum Reprod. 2003; 18:849–852. PMID: 12660283.
Article
49. Fargeaudou Y, Soyer P, Morel O, Sirol M, le Dref O, Boudiaf M, et al. Severe primary postpartum hemorrhage due to genital tract laceration after operative vaginal delivery: successful treatment with transcatheter arterial embolization. Eur Radiol. 2009; 19:2197–2203. PMID: 19415291.
Article
50. Soyer P, Morel O, Fargeaudou Y, Sirol M, Staub F, Boudiaf M, et al. Value of pelvic embolization in the management of severe postpartum hemorrhage due to placenta accreta, increta or percreta. Eur J Radiol. 2011; 80:729–735. PMID: 20708361.
Article
51. Izbizky G, Meller C, Grasso M, Velazco A, Peralta O, Otaño L, et al. Feasibility and safety of prophylactic uterine artery catheterization and embolization in the management of placenta accreta. J Vasc Interv Radiol. 2015; 26:162–169. quiz 170. PMID: 25533451.
Article
52. Shrivastava V, Nageotte M, Major C, Haydon M, Wing D. Case-control comparison of cesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters for placenta accreta. Am J Obstet Gynecol. 2007; 197:402.e1. 402.e5. PMID: 17904978.
Article
53. Yu PC, Ou HY, Tsang LL, Kung FT, Hsu TY, Cheng YF. Prophylactic intraoperative uterine artery embolization to control hemorrhage in abnormal placentation during late gestation. Fertil Steril. 2009; 91:1951–1955. PMID: 18501901.
Article
54. Hequet D, Morel O, Soyer P, Gayat E, Malartic C, Barranger E. Delayed hysteroscopic resection of retained tissues and uterine conservation after conservative treatment for placenta accreta. Aust N Z J Obstet Gynaecol. 2013; 53:580–583. PMID: 24138386.
55. Diop AN, Chabrot P, Bertrand A, Constantin JM, Cassagnes L, Storme B, et al. Placenta accreta: management with uterine artery embolization in 17 cases. J Vasc Interv Radiol. 2010; 21:644–648. PMID: 20227296.
Article
56. Uchiyama D, Koganemaru M, Abe T, Hori D, Hayabuchi N. Arterial catheterization and embolization for management of emergent or anticipated massive obstetrical hemorrhage. Radiat Med. 2008; 26:188–197. PMID: 18509718.
Article
57. Wang Z, Li X, Pan J, Zhang X, Shi H, Yang N, et al. Uterine artery embolization for management of primary postpartum hemorrhage associated with placenta accreta. Chin Med Sci J. 2016; 31:228–232. PMID: 28065219.
Article
58. Kim T, Shin JH, Kim J, Yoon HK, Ko GY, Gwon DI, et al. Management of bleeding uterine arteriovenous malformation with bilateral uterine artery embolization. Yonsei Med J. 2014; 55:367–373. PMID: 24532505.
Article
59. Aziz N, Lenzi TA, Jeffrey RB Jr, Lyell DJ. Postpartum uterine arteriovenous fistula. Obstet Gynecol. 2004; 103(5 Pt 2):1076–1078. PMID: 15121613.
Article
60. Maleux G, Timmerman D, Heye S, Wilms G. Acquired uterine vascular malformations: radiological and clinical outcome after transcatheter embolotherapy. Eur Radiol. 2006; 16:299–306. PMID: 15977019.
Article
61. Pelage JP, Le Dref O, Mateo J, Soyer P, Jacob D, Kardache M, et al. Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization. Radiology. 1998; 208:359–362. PMID: 9680559.
Article
62. Touboul C, Badiou W, Saada J, Pelage JP, Payen D, Vicaut E, et al. Efficacy of selective arterial embolisation for the treatment of life-threatening post-partum haemorrhage in a large population. PLoS One. 2008; 3:e3819. PMID: 19043573.
Article
63. Isono W, Tsutsumi R, Wada-Hiraike O, Fujimoto A, Osuga Y, Yano T, et al. Uterine artery pseudoaneurysm after cesarean section: case report and literature review. J Minim Invasive Gynecol. 2010; 17:687–691. PMID: 20656567.
Article
64. Ko SY, Park SW, Sohn IS, Lee JY, Kwon HS, Hwang HS, et al. Interventional management for complications following caesarean section. Br J Radiol. 2011; 84:204–209. PMID: 20959367.
Article
65. Yalamanchili S, Harvey SM, Friedman A, Shams JN, Silberzweig JE. Transarterial embolization for inferior epigastric artery injury. Vasc Endovascular Surg. 2008; 42:489–493. PMID: 19000984.
Article
66. Deux JF, Bazot M, Le Blanche AF, Tassart M, Khalil A, Berkane N, et al. Is selective embolization of uterine arteries a safe alternative to hysterectomy in patients with postpartum hemorrhage? AJR Am J Roentgenol. 2001; 177:145–149. PMID: 11418416.
Article
67. Sierra A, Burrel M, Sebastia C, Radosevic A, Barrufet M, Albela S, et al. Utility of multidetector CT in severe postpartum hemorrhage. Radiographics. 2012; 32:1463–1481. PMID: 22977030.
Article
68. Lee NK, Kim S, Lee JW, Sol YL, Kim CW, Kim HS, et al. Postpartum hemorrhage: clinical and radiologic aspects. Eur J Radiol. 2010; 74:50–59. PMID: 19477095.
Article
69. Takeda A, Koike W, Imoto S, Nakamura H. Three-dimensional computerized tomographic angiography for diagnosis and management of intractable postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol. 2014; 176:104–111. PMID: 24630300.
Article
70. Roy-Choudhury SH, Gallacher DJ, Pilmer J, Rankin S, Fowler G, Steers J, et al. Relative threshold of detection of active arterial bleeding: in vitro comparison of MDCT and digital subtraction angiography. AJR Am J Roentgenol. 2007; 189:W238–W246. PMID: 17954618.
Article
71. Lee NK, Kim S, Kim CW, Lee JW, Jeon UB, Suh DS. Identification of bleeding sites in patients with postpartum hemorrhage: MDCT compared with angiography. AJR Am J Roentgenol. 2010; 194:383–390. PMID: 20093600.
Article
72. Kawamura Y, Kondoh E, Hamanishi J, Kawasaki K, Fujita K, Ueda A, et al. Treatment decision-making for post-partum hemorrhage using dynamic contrast-enhanced computed tomography. J Obstet Gynaecol Res. 2014; 40:67–74. PMID: 23937115.
Article
73. Heaston DK, Mineau DE, Brown BJ, Miller FJ Jr. Transcatheter arterial embolization for control of persistent massive puerperal hemorrhage after bilateral surgical hypogastric artery ligation. AJR Am J Roentgenol. 1979; 133:152–154. PMID: 110056.
Article
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